Registration Info
First Name
Last Name
Male/Female
Birth Date (Month/Day/Year)
Age
Name of Parent/Guardian if under 18
Street Address
City
State
Country
Zip Code
Home or Cell Phone
E-mail
Rank/Style
Organization/Federation Association
I hereby submit my registration to the 2010 IIMAA Training Conference. I agree to save & hold harmless the IIMAA Training Conference, IIMAA, East Coast Training Systems llc, USBA/WBA (USBA llc), The Gaylord Palms, Management, Sponsors, their officers, agents, members & employees from any & all liability resulting from injuries to any person or for damages to or loss of property owned or controlled by me. I fully understand and shall adhere to all rules and regulations. I release all photo & video rights that may be used for publicity, promotion and/or media release without any form of compensation.	Cancellation Policy: The IIMAA Training Conference reserves the right to cancel event if necessary. If cancelled IIMAA Training Conference will provide a full refund of all attendance fees, training vouchers, cocktail party, kids night out, seminar and certification fees, and all other related funds paid to the 2010 IIMAA Training Conference.
Signature (Parent or Guardian if under 18): Your signature confirms that you have read and approve of the above release and cancellation policy. Your entry at right will act as your signature

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